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Examined Lives: A med student learns to listen

I remember the first story. It was my first day of eight months working in an HIV clinic in Trinidad; I was unsure of where to go, when a young woman sat beside me. She looked to be in her late 30s. HIV had begun to ravage her body, her bones eerily visible, her teeth chattering with fever. She simply started talking, as if she had been waiting for this moment to tell her story. I listened. This woman taught me volumes about HIV and a person’s experience with a disease that carries such stigma. What I remember most though, is when she told me about her boyfriend. “He loved me,” she said. “He knew he was sick and he kept telling me, ‘Don’t be like me. Don’t you be like me.’”

Nichole Boisvert in Cambodia, where she worked with a medical NGO.

The ideas of narrative medicine enlivened me from the moment I heard them at a conference nearly five years ago. I had recently “converted” from my fourteen-year dream of veterinary medicine to “people medicine” because I simply wanted to do more to help, and with human medicine, I could save lives, heal, or be present and fight for patients who needed it. I was filled with ideals. I still am. Naomi Shihab Nye told me once that without idealists in the world, no good would ever happen, and I try to live by that. I felt elated and affirmed that these ideals of how I wanted to practice medicine—to be present, to listen, to work the person’s story into the standard history and physical—could be reality. From that point, I read as much as I could by physician-writers like Danielle Ofri and Abraham Verghese, and read Narrative Medicine; Honoring the Stories of Illness by Rita Charon, a pioneer of the narrative medicine movement from Columbia University. I wanted to learn how to listen, how to carve out time, how to maintain compassion.

Everywhere I turn, there are stories. In Trinidad, part of my job as a clinic volunteer was simply to sit and listen to patients share their experiences, their fears, their hopes. I could borrow an office, sit beside a hospital bed, and just be present. These patients told me of stigma and strength, of abandonment and suffering and the things that kept them alive. They gave me Winnie the Pooh stickers, mangoes, and perspective.

Patients in Cambodia take a number to receive treatment; a shortage of medical personnel means that many will be turned away.

As a medical student, perhaps one of the greatest blessings is the gift of time. We are only expected to carry only three or so patients on any clinical rotation, and so have the ability to spend the extra ten minutes just to listen. In these moments, I have heard sources of strength in the patient who told me of her developmentally delayed 12-year-old, or the man who told me that he had just got married in the hospital a month ago, after coming out of a coma. I have picked up on idiosyncrasies that indicated cognitive decline and felt edges of fear in questions about a recent diagnosis.

Rita Charon once wrote, “I was thinking of receiving the stories as gifts.” There truly is no greater privilege then to be allowed to bear witness to someone, particularly in the place of vulnerability that is a medical setting. It is a chance to see the individual behind the illness. As a future physician, it is my duty to take those extra few minutes and listen, notice; healing is not simply eradication of the physical maladies but, as is present in Georgetown University’s motto, cura personalis, care of the whole person.

Nichole Boisvert is a third-year medical student at Georgetown University. For more from our narrative medicine series, click here.

Great piece, Nichole! As a soon to be intern, I am disappointed that I will not have nearly the opportunity that as been afforded me over the past two years to spend time speaking with patients and hearing their stories. I can already anticipate experiencing the struggle of wanting to spend more time talking to my patients in the morning seeing my patients, but I know that if I did that I would never be done in time for rounds. Fortunately, I have learned from some of the best clinicians that one does not need much time to bond and connect with their patients if it is done properly. I’ll be going in to emergency medicine where rapport is often built in minutes. I believe this is in part to body language and being in the moment with the patient. Offering a few words of empathy – not compassion – can sometimes be the most meaningful gestures. There is no way I could possible understand what it would be like to experience devastating trauma or life-long chronic illesses, but I can try to appreciate the patient’s struggles and see things through their perspective. Perhaps by doing this, I can best be their advocate. Thank you for a great reminder about how important it is to listen – and remember why many of us chose this amazingly rewarding profession!

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